Forms Addendum 2

ACKNOWLEDGEMENT OF RESPONSIBILITIES AND CONSEQUENCES I, ---------- � understand that I must comply with the following. I acknowledge and agree to each provision by initialing each paragraph below. __ Both parties must complete and exchange this six-page affidavit at least three days before a court hearing where financial matters are at issue. The affidavit must be provided to opposing counsel, if a party is represented, or directly to a self-represented litigant. __ Both parties must supply the original notarized affidavit to the court. __ If I am employed, I must attach copies of my last three paystubs to this affidavit. __ If I am self-employed, I must attach copies of my last two federal and state tax returns, including all schedules, to this affidavit. __ Before each court hearing where financial matters are at issue, I will review this document and provide updated information to the other party and to the court. __ I understand that the cost of dependent health insurance coverage is the difference between self­ only and self with dependents or family coverage or the cost of adding the child(ren) to existing coverage.

rstand that the cost of dependent health insurance coverage is the difference between self­ only and self with dependents or family coverage or the cost of adding the child(ren) to existing coverage. __ I understand that failing to comply with these provisions, or deliberately attempting to mislead the court or the opposing party, may result in my being held in contempt of court, being fined, being ordered to pay attorney's fees, and/or being sentenced up to 6 months in jail, and that serious violations can result in prosecution for felony perjury-punishable by 3 to 1 0 years in prison. Date Signature I certify that I have reviewed this affidavit with my client and advised him or her of the importance of providing true, correct, complete answers and the required exhibits. Date Attorney Form Revised 4/2020 Page 6 of6 Initials Initials